The purpose of the proposed study is to conduct a controlled evaluation of two approaches to the amelioration of children's pain and anxiety in response to bone marrow aspiration and lumbar prunctur procedures. The first approach consists of a package of behavioral strategies combining clearly defined components: modeling, relaxation, cognitive attention-distraction, and reinforcement. The second approach is a drug preparation consisting of Demerol, Phenergan, and Thorazine, also commonly referred to as the "lystic cocktail". In addition, these strategies will be compared to a minimal treatment, attention control group. The importance of the proposed study is highlighted by the fact that bone narrow aspirations and lumbar punctures have been described by children with cancer as the most painful and traumatic events in the entire therapeutic sequence of cancer treatment. Unfortunately, in both medical and psychological literature, only curory attention has been paid to the management and/or amelioration of children's response to such painful situations. A preliminary study has been completed and described by the current authors. This study was considered to be a prerequisite to the development of a well controled treatment intervention study in that it provided data on the following: 1) reliability and validity of an observation scale for the assessment of children's behavioral distress; and 2) the relationship between a wide variety of psychosocial and medical factors and children's subsequent distress during the painful medical procedures. The methodology of the proposed study will involved 36 pediatric cancer patients in a complete counterbalance design. This design will expose all subjects to all treatment conditions (behavior therapy package, medication, and minimal treatment attention-control), but in six different sequence groups. Due to the multidimensional nature of anxiety and pain, sophisticated measures of behavioral, physiological, and cognitive response systems will be used to measure children's distress concomitant with the medical procedures. The relative efficacy and practicality of these approaches will have sustantial implications for the future routine management of the extreme distress experienced by the pediatric cancer patients during noxious medical procedures.